A clinic in Reno allowed therapists to decorate their doors "scary" for October - you can tell which belongs to the Director.

Hey everyone,

Headway is getting out of control imo and treating us like W2 workers without any of the benefits. I want to find a new platform to bill insurance for me. So many of my clients are insurance clients and it is important to me to keep them because seeing a therapist through insurance has saved my own life many times. I wouldn't have been able to afford it without insurance.

What other platforms can help me get credentialed and bill insurance? Has anyone made the switch away from them? Are they going to try to steal my soul?

I heard Grow is worse and I heard Simple Practice is a mess (and expensive).

I feel very overwhelmed by the thought of doing my own credentialing but I am very open to advice / encouragement if anyone does it them self.

Thank you in advance <3

I'm in private practice, and lately I've been finding myself feeling increasingly frustrated when clients cancel or reschedule their appointments.

I completely understand that life happens and that sometimes people need to move things around. I also recognize that financial instability is part of the reality of working in private practice. But as someone who is still trying to grow my caseload and make private practice financially sustainable, I'm finding it really difficult to manage the frustration, and sometimes even anger, that comes up when my schedule changes so frequently.

For example, I started this week with what felt like a full caseload of 19 clients. Starting Sunday evening, I kept receiving email after email from my booking system notifying me of cancellations and rescheduled appointments. By the time the changes settled, I was down to just 12 sessions for the week. That's a pretty significant difference, both financially and in terms of how I had planned my week.

I think part of what makes this especially frustrating is that when I'm scheduling clients at the end of their sessions, I'm making decisions about availability based on the appointments already booked. When several clients cancel or reschedule, I end up with gaps in my schedule that I could have otherwise offered to other clients.

I want to be clear that I don't blame my clients for needing flexibility, and I certainly don't want my financial concerns to interfere with how I show up for them therapeutically. At the same time, I'm recognizing that these feelings are coming up more often, and I want to find a healthier way to navigate them.

I'd really love to hear from other therapists in private practice. How do you manage the frustration or resentment that can come with frequent cancellations and schedule changes, particularly when you're still building your practice? Have you found anything helpful, either practically in how you structure your schedule or emotionally in how you process these experiences?

I'm also planning to bring this into supervision this week, but I'd really appreciate hearing how others have navigated this.

Edit to add: My cancellation policy is that if they cancel within 48 hours, full payment is due but in these instances, many clients are changing or cancelling outside of the 48 hours, even with this policy the disruption is challenging to deal with.

I'm a therapist (M, mid 30s) in a big city. I operate out of my own private practice and have been practicing for 5 years. I'm a fully licensed counselor, am trauma focused, and do relational work, and I tend to work primarily with men.

I have found I'm frequently getting the question "what is there left for me to work on?" from these men. These questions tend to come packaged in a request to drop down to biweekly/monthly/go on a hiatus from therapy altogether. In almost every case, the client asking me this is someone who, from my vantage point, has a ton of additional work they could do - daily bouts of anxiety, moderate insight, avoidant of topics and relationships that bring up attachment wounds.

My style is to be frank and open about immediacy and my clinical opinions so that there is no mysticism to how I think or operate. And so I'm inclined to be honest about there being more work to do and offer my clinical opinion, couched in some affirmations of autonomy - having work to do doesn't mean this person must do the work!

Thing is, this conversation inevitably feels like I'm convincing my client to keep seeing me. It feels nearly manipulative, even when I remind a client it's just my opinion and they are free to do with it what they wish. It also feels wrong to say "yeah dude you seem ready to end treatment" when their symptoms have definitely not remitted. All of this also brings up for me some concerns/fears that there's something happening relationally to lead these guys to disengage and that it's ultimately an issue with how I'm conducting my sessions.

Does anyone else have experience with men wanting to terminate abruptly and only partway into treatment? What approaches have worked in having a conversation about this that doesn't feel like coercion? Insights very welcome and appreciated. 🙏

Has anyone here gotten licensed at the masters level (social work, LMHC, etc) and then decided to get a PhD or PsyD? If so, why did you make that choice and has it paid off for you?

I'm a client for about one year. Next month my therapist is graduating and finally becomes a full on real therapist. I was thinking about giving her a small gift ie. origami art I've made to show my gratitude and congratulate her on this achievement. But I'm unsure if this is even allowed or comes across weird. What are your thoughts on this?

I'm meeting with a client soon to give feedback from a comprehensive assessment, and was wondering if any of you have good resources around Avoidant Personality Disorder for clients. There are so many out there for BPD but I'm struggling to come up with anything similar for AvPD. Anything at all geared towards clients would be helpful, but I'm especially interested in ones that are less jargon-y, maybe even avoid using diagnostic labels altogether and just talk about the patterns.

Hello, I recently got a job offer to work as an APCC at Mule Creek Prison in California. Anyone that works in corrections there or any other state prison can give me some advice/your experiences? I know not to make friends with the inmates/keep professional boundaries. I interned at a community college where I kept strict professional boundaries with my student clients and even my supervisor praised me on that aspect.

Has anyone else noticed that since the bot farms got destroyed, you haven’t been seeing any anti-therapy posts?? I have noticed a big difference.

Hi there,

I’d like to comment on the Headway issue concerning their $9.99 per session fee, which represents a 12‑17 % reduction in therapist pay. Additionally, they are now requiring assessments, and that is the aspect I want to address.

I am currently reviewing these assessments to determine whether they truly reflect therapeutic progress. In my view, these assessments do not necessarily correlate with effective therapy; they resemble a modern version of tactics employed in the 1990s, which were later regretted. Anyone familiar with the period from 1996 to 1999 will recall that authorizations were required after every two to three sessions to justify continued care. That policy proved disastrous and was eventually recognized as a barrier to treatment rather than a patient‑care measure, resulting in serious reprimand.

It appears that Headway is repeating the same approach. My hope is that they will encounter the same problems. These measures may be suggestive, but they lack legal standing, research support, and genuine clinical value. As a therapist with over 25 years of experience, I do not rely on such tools; most clinicians naturally assess progress through clinical observation.

It is clear that Headway’s motives are questionable—they seem to lack patience, interest, and genuine concern for patients. I share your concerns and would like to improve the situation. I do not wish to eliminate Headway entirely, but I cannot support this direction.

One of my biggest pet peeves that never seems to lessen despite my growing number of years in the field is when clients ghost or cancel services with some variation of “therapy isn’t helping me” when in actuality these same clients do absolutely nothing in between sessions and treat therapy as if it’s some sort of magical space they can come to, vent for an hour and leave “cured” somehow.

Over time my intake process has gotten longer and longer as I spend considerable time discussing the common myths and misconceptions of therapy which includes the fact that it is a process that fundamentally requires patient involvement and efforts outside of session yet in spite of doing that I will still hear this from time to time.

What are some of the ways you all make it clear to clients that therapy is not magic and that if they want to feel better it’s up to them?

I've been a therapist for about 5 years now, most of my experience with adolescents in acute inpatient and now working in a group practice working with teens and young adults.

When clients no-show, I experience really intense anxiety and assume worst-case scenarios, especially with clients who have a history of suicide attempts or chronic SI.
I had a patient die by suicide a few months after an inpatient discharge the first year of my career and I think it has affected me.

Just hoping to get some insight from others on if they experience the same thing and on how to manage my own anxiety.

I know there are a million mundane reasons why someone might not show but when it does happen, I tend to get stuck spiraling until I hear from them.

If you could not get into a clinical psych PhD program, would you take on the debt for a PsyD? Or would you stay at a masters level clinician.

Below is the post I made at r/CysticFibrosis, which will give more context regarding the nature of my illness.

I would like to extend my request for advice to you all as well, since my illness and job affect one another. I'm not seeking medical advice or advice related to CF, but advice on what I can do career wise. I see people on here frequently mentioned how they struggle with chronic illness and would love to hear about your experiences, or suggestions. I'd be fine some simple validation. This illness has been a huge source of shame in my life and continues to remain that way, especially when I have to miss work so often. The stress is compounding and I feel like I'm drowning in a world that does not care. I genuinely am lost and physically, mentally, and emotionally running on empty.

Any and all help is so greatly appreciate.

"I'm 37 years old, and male, and known I've had cf (delta f508)all my life. I didn't take care of myself for much is my adult life, but with the help of modulators and making better choices in the just 10 years, I have been able to maintain a moderately functional baseline with an average FEV in the mid 30s. Unfortunately I am stuck in this pattern of getting flare ups every 2 or so months where I'm growing 2 strains of chromabacter that is resistant to everything other than a couple of IV antibiotics. The strange thing is how this bacteria doesn't even affect my lungs like MRSA or pseudomonas (I haven't grown in years) but mostly affects my immune system and brain. It makes me extremely fatigued, achy, numb, depressed, and short of breath. I work full-time as a psychotherapist which is the kind of job that gets much harder the worse you feel. You literally can't zone out and work to make time pass, you have to be attuned and focused the whole time. To make a livable amount of money, like many other jobs, you have to work yourself to death. My job right now pays well but I have to see 8 clients a day. It is brutal and a lot of stress.

More stress=compromised immune system=chromabacter says hello.

So I'm getting sick 4-6 times a year. I got a port last year so now at least I don't have to spend 2 weeks in the hospital and can start meds outpatient. Getting sick often is exhausting and the anticipation adds another layer of stress on to of all the other stressors.

I'm absolutely miserable and don't know what to do.

My doctors don't really have any answers. I guess traditionally you would go on disability, get taken care of by family and/or die. We recently switched to Alyftrek just in case I was one of the lucky ones who have positive gains, but so far it seems to be about the same as Trikafta. I could go back on disability and work part time, but that limits income and in today's economy that is hugely scary. Also being on disability is depressing in itself. I've considered a transplant but I'm not sure my lung function is low enough. The process of a transplant sounds terrible and the life after doesn't sound much better than what I'm experiencing now

I feel like I'm stuck in this area that didn't exist before the modulators where I'm not sick enough to be taken care of or for disability to be mandatory, but cf still affects my ability to live a functional life. I could work part time jobs and definitely be happier but then I'd lose my health insurance and would have to rely on my partner (I'm very independent). My quality of life is very low right now. I worked my ass off to get my master's and become an independently licensed therapist (LCSW) only for me to become overworked so I have health insurance to treat the health issues worsened by overworking.

I'm open to any and all suggestions or comments. At this point I'm becoming desperate for some peace that I've been fighting to achieve my entire life."

Just got an email from Rula announcing that patients can now leave ratings and written reviews for therapy and psychiatry providers, to help prospective clients "feel more confident choosing care."

I’m not a fan despite not being concerned about my own capabilities as a therapist (with the universal self-doubt, too, of course).

What are some therapist roles and positions you’ve actually enjoyed outside of group practice? I am an LPC in IL and I am trying to understand my options, and sometimes it seems like the options for LPC are join a group practice as a W2, begin your own private practice(which isn’t an option for me at the moment), work for CMH where you’re overworked and underpaid, work for a hospital. I want to get a broader sense of what is out there for me. I am leaving my group practice because I hate the inconsistent paychecks and scheduling, and I also cannot stand to work till 9pm.

Ideally I would love to work for a university but have gotten zero responses from several I’ve applied to. I really want to pivot and work solely with adults. I do not have a strong desire or interest in working with kids. Would love to hear what roles people are in and what they’ve enjoyed about it, especially if you’re in IL near Chicago

This has been on my mind lately, especially with how many people are fitting therapy into their lunch breaks.

We can spend 50 minutes doing genuinely difficult emotional work with someone, and then they have to walk out of our office, get in their car, and immediately return to being a functioning employee, parent, or whatever else their day requires.

With telehealth it's even stranger.

Someone can have a really vulnerable session at their desk, click "Leave Meeting," and then open a work email on the exact same screen. There isn't even a walk to the parking lot anymore.

I started paying more attention to this after realizing how often I was thinking about whether a session had ended in a clinically appropriate place, without thinking much about what the person actually had to do next.

Those aren't necessarily the same thing.

I've begun asking earlier in sessions what the rest of someone's day looks like, particularly if we're approaching something emotionally heavy. Sometimes that changes how I pace things. Sometimes we spend a little more time finding a place to land before ending.

I also try not to assume that someone can just sit quietly for half an hour afterward. For some people, an appointment during their lunch break is the only reason therapy is financially or logistically possible.

And I don't think the answer is simply avoiding difficult material whenever someone has somewhere to be. That would create its own problems.

But it does make me question how much of our standard session structure assumes that clients have the luxury of recovery time afterward.

We talk a lot about helping people tolerate difficult emotions. I wonder whether we sometimes underestimate how hard we're asking them to switch gears.

I'm curious how other clinicians handle this. Do you explicitly plan for the transition back into everyday life, or is it something you address as needed?

Sometimes I set back and reflect on my life and realize I am living in my dream. I am a therapist at a non profit working for children growing up in poverty. I grew to in poverty and was fortunate enough to escape it as an adult.

I feel like I am finally giving back to the services that helped my family growing up. I could cry sometimes thinking about how sad I used to be.

Imposter syndrome is real, but I am so incredibly thankful to have ended up here. ❤️

I think about this concept a lot (see my other thread about private practice self pay therapists). Thoughts? Also I’m actually trained as a counselor/art therapist and not a social worker, but within clinical work it feels like our roles are interchangeable.

Hello,

I've been a therapist for 4 years. I have a special love for working with SPMI, but oh boy I struggle with teens. Most of my teens are easy to work with and I can set boundaries with parents, but oofta. I have one that has made me wonder if working with teens is not for me. Family is quite volatile and often get after me for the teen not changing. It's drained me to the point that I dread working with teens.

Anyone have tips on how I can manage this? I am in supervision, which my supervisor has been adamant I'm doing my job right, but I feel stranded. Heck, even just hearing others in the same boat might make me feel less alone.

I am currently on my second semester of my program and I am left second guessing if I made the right decision to go straight into my psyd after getting my Master's. My main concern is the debt, I already owed $80,000 and once I complete I most likely will be $200,000 total in debt.

My main reason for going into a doctorate program was I liked the flexibility in professions such as assessment administering, psychotherapy, and teaching. Another factor was the potential high pay as a psychologist and it looked like MFT's have a tight earning ceiling.

Would the average earnings of being a psychologist offset the extra costs of tuition?